Sterilization

Sterilization, in medicine, surgical procedure for the permanent prevention of conception by removing or interrupting the anatomical pathways through which gametes—i.e., ova in the female and sperm cells in the male—travel.

The oldest form of surgical sterilization, tubal ligation, remains one of the most widely used. As originally performed, this consisted of tying the female’s fallopian tubes closed with silk thread. Simple ligation has a high failure rate, however, and modern procedures usually rely on stitching the tubes closed or severing a section of the tubes, making the possibility of reopening the pathway remote. Tubal closure may also be achieved by electronic coagulation of a segment of the tubes or by chemical adhesives. Occlusive devices—clips or bands of metal or some other material—may be used to close the tube. Techniques involving clips and bands are less destructive to the uterine tubes and generally have higher reversal rates than other methods. Tubal ligation can be performed through an open incision or endoscopically and often requires the use of general anesthesia.

Permanent sterilization in females can also be achieved through a nonsurgical procedure known as Essure. In this approach, the doctor uses a flexible lighted instrument known as a hysteroscope to insert and place a soft coil implant into each of the fallopian tubes. The instrument, which is attached to a camera to visualize tissues and guide implant placement, is inserted through the vagina and uterus to reach the tubes. Once in place, the coils are expanded to block the tubes. Over a period of time, scar tissue develops around the implants, with complete blockage and permanent sterilization taking place within three to six months. The procedure requires only local anesthesia.

Male sterilization is performed in an operation known as vasectomy. In this procedure, each vas deferens, through which sperm is transmitted, is severed through a small incision in the scrotum. This method gained popularity as a form of contraception beginning in the 1950s. Today it is a common procedure in many countries for permanent sterilization. Compared with tubal ligation in females, vasectomy involves less risk to the subject and is simpler and less expensive. However, because it involves an incision and stitches, it is more invasive than the Essure procedure for females.

Because a sterilized individual may at some point desire restored fertility, the chief drawback of sterilization as a contraceptive means has been its irreversibility. Some tubal closures have been reversed using microsurgical techniques, but the procedure is difficult and expensive. It has had only limited success at restoring a woman’s fertility, because other damage associated with the original sterilization may prevent successful conception. Surgical reversal of vasectomy is somewhat more successful, achieving success about 80 percent of the time, but the conception rate following such reversal remains low.